1st Department of Obstetrics
and Gynecology,
University of Milan, Italy.

Serial decompressive amniocenteses
were performed
at 18-23 weeks of gestation in 23 pregnancies referred
due to echographic signs typical of twin-twin transfusion
syndrome. The procedures were repeated until delivery
or permanent normalization of the amniotic fluid volume
both in the donor and the recipient twin sac. The overall
survival rate was 57%, but in only 39% of the pregnancies
did both twins survive without handicaps. The absence
of end diastolic flow in the umbilical artery of the donor
twin was associated with poor chances of survival for
both fetuses; in contrast, the presence of hydrops or
ascites in the recipient twin did not worsen the prognosis.
A policy of aggressive amniotic fluid decompression
may achieve permanent resolution of the fluid in over
50% of the pregnancies complicated by twin-twin transfusion
syndrome.